Discount Registration Code Application for Attendees in Low- and Middle-Income (Tier 3 and 4) Countries

Discount Registration Code Application for Attendees in Low- and Middle-Income Countries (World Bank Tier 3 and 4 Countries)
Institution*
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email - Must be from your institution*
example@example.com
If issued, upload a photo of your Institutional Badge/ID

Cancelof
I am a:

MemberNon-member
Field of expertise:

PhysicianAdvanced Practice ProviderNurse / Resident / Fellow/ Other Allied Health
I am requesting a registration discount code for the following event:*
Have you attended a PCICS Annual Meeting before?

YesNo
Should be Empty:

Discount Registration Code Application for Attendees in Low- and Middle-Income Countries (World Bank Tier 3 and 4 Countries)